输尿管结石合并上尿路尿路上皮癌临床分析

Clinical analysis of ureter calculi associated with upper tract urothelial carcinomas

目的:探讨输尿管结石合并上尿路尿路上皮癌的临床特点和诊疗方法。方法:回顾分析8例输尿管结石合并上尿路尿路上皮癌病例资料,并结合文献进行讨论。结果:8例中5例为输尿管结石合并输尿管癌,其中3例术前确诊,2例为输尿管镜取石术中发现输尿管肿物。3例为输尿管结石合并肾盂癌,其中2例术前确诊,1例为输尿管镜取石术后血尿不缓解,复查增强CT发现肾盂肿物。8例均行后腹腔镜肾、输尿管全长切除加膀胱袖口状切除术。术后病理结果均为高级别尿路上皮癌,其中3例伴局部鳞癌样分化。结论:上尿路尿路上皮癌与输尿管结石关系密切,且结石引起的梗阻、积水、感染等症状极易掩盖上尿路尿路上皮癌的症状,造成漏诊,临床上应予以重视。

Objective： To explore the diagnosis and treatment of ureter calculi associated with upper tract urothelial carcinomas. Methods： Retrospective analysis of clinical data of 8 cases with ureter calculi associated with upper tract urothelial carcinoma was conducted. Results：Five cases were ureter calculi associated with ureter carcinoma, three of which were diagnosed before operation.The other 2 cases were diagnosed with ureter tumor when performed with URL. Three cases were ureter calculi associated with renal pelvic carcinoma.Two were diagnosed before surgery.One case with hematuria recurring after URL received enhanced CT scan to reveal pelvic carcinoma. All of the 8 cases were performed with nephroureterectomy . All of the pathological outcomes were high grade urothelial carcinomas, three cases with local squamous cell carcinoma differentiation. Conclusion： The upper tract urothelial carcinoma and ureter calculi are closely related, and the obstruction, hydronephrosis, infection and other symptoms caused by stones can easily make the symptoms of upper tract urothelial carcinoma overlooked, resulting in missed diagnosis of upper tract urothelial carcinoma. Clinicians should attach importance to this rare dis- ease.